Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: A systematic review and meta-analysis

作者：Junjie Hu, Yan Chen, Sijin Cheng, San Zhang, Kaiqin Wu, Wenli Wang, Yongxin Zhou · 发表于：Journal of Cardiac Surgery · 年份：2018 · DOI：10.1111/jocs.13767 · 被引用次数：48 · 研究领域：Cardiac Valve Diseases and Treatments、Cardiac and Coronary Surgery Techniques、Infective Endocarditis Diagnosis and Management

BACKGROUND: Transcatheter mitral valve-in-valve (TMVIV) and valve-in-ring (TMVIR) implantation for degenerated mitral bioprostheses and failed annuloplasty rings have recently emerged as treatment options for patients deemed unsuitable for repeat surgery. METHODS: A systematic literature review was conducted to summarize the data regarding the baseline characteristics and clinical outcomes of patients undergoing TMVIV and TMVIR procedures. RESULTS: A total of 245 patients (172 patients who underwent TMVIV surgery and 73 patients who underwent TMVIR surgery) were included in the study; 93.5% of patients experienced successful TMVIV or TMVIR implantation. The mortality rates at discharge, 30 days, and 6 months were 5.7%, 8.1%, and 23.4%, respectively. The transapical (TA) access route was used in most procedures (55.2%). The TA and transseptal (TS) access routes resulted in similar outcomes. No significant differences were observed in the short-term outcomes between the patients who developed mitral stenosis versus mitral regurgitation as the mode of failure. CONCLUSIONS: TMVIV and TMVIR implantation for degenerated mitral bioprostheses and failed annuloplasty rings are safe and effective. Both procedures, via TA or TS access, can result in excellent short-term clinical outcomes in patients with mitral stenosis or regurgitation, but long-term follow-up data are currently lacking to determine the durability of these procedures.